Surgical Approach in Difficult Tibial Pilon Fractures

Aim: The aim of the present study is to emphasize the optimalmoment and approach for tibial pilon complex fractures andtheir complications.Material and methods: We have investigated and treated 7patients with complex fractures of the tibial pilon withtendencies to complications. According to AO classification,we have recorded 4 fractures type 43C2 AO, 2 fractures type43C3 AO (with one open fracture type IIIA Gustilo) and 1fracture type 43B3 AO. According to soft tissue status, surgicaltreatment was performed by a one-step or two-step approach.Results: All fractures healed after an interval of 13.6 weeks(range 8-28 weeks) with one delayed consolidation. The openfracture was complicated by posttraumatic arthrosis. Noinfections or implant failures were recorded. According toOvadia score, objective and subjective evolution showed goodresults in 5 cases, one excellent result and one poor result.Conclusions: Fracture type and the soft tissue status are crucialfor the results of operated fractures. These arguments determinethe application of one-step or two-step surgical procedure aswell as optimal implant choice.

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